2013 Webinar Series #6 –
ICD-10 Coding Questions & Answers
August 20, 2013
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Today’s Panelists:
Sandy Giangreco, RHIT, CCS, RCC, CPC, CPC-H, CPC-I, PCS,
AHIMA Approved ICD-10 CM/PCS Trainer
CHIMA ICD-10 Task Force
Robin Linker, CHCA, CHCAS, CPC-I, CCS-P, CPC-H, CPC-P, MCS-P, CHC
Approved ICD-10-CM / PCS Trainer (AHCAE, AMA, AAPC)
Robin Linker & Associates, Inc. and
Executive Director, Association of Health Care Auditors and Educators
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ICD-10-CM Basics
• ICD-10-CM is very similar to
ICD-9-CM as far as look up
and basic guideline
information
• Total number of codes
expands from about 14,000
ICD-9-CM codes to well over
68,000 in ICD-10-CM
• ICD-10 Uses full code titles,
ICD-9 does not
• Plenty of room for expansion
in ICD-10
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ICD-9-CM Diagnosis Codes
Are 3–5 digits;
•The first digit is alpha (E or V) or numeric
(alpha characters are not case sensitive);
•Digits 2–5 are numeric; and
A decimal is used after the third character. Examples: • 496
– Chronic airway obstruction, not elsewhere classified (NEC);
• 511.9 – Unspecified pleural effusion; and • V02.61 –
Hepatitis B carrier
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ICD-10-CM Diagnosis Codes
Are 3–7 digits;
•Digit 1 is alpha;
•Digit 2 is numeric;
•Digits 3–7 are alpha or numeric
(alpha characters are not case sensitive); and
A decimal is used after the third character.
Examples: • A78 – Q fever; • A69.21 – Meningitis due to
Lyme disease; and • S52.131A – Displaced fracture of neck of
right radius, initial encounter for closed fracture.
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ICD-10-CM Code Structure
Category
first three
characters
M84 Disorder of continuity
of bone
Etiology, anatomic site,
severity, fourth, fifth, sixth
characters (if applicable)
M84.311- Stress fracture,
right shoulder
Extension
seventh
character
(if applicable)
M84.311A Stress fracture, right
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shoulder; initial encounter
New Features in ICD-10-CM
• Laterality (Left, Right, Bilateral)
• Combination codes for certain conditions and
common associated symptoms and manifestations
• Combination codes for poisonings and their
associated external cause
• Obstetric codes identify trimester instead of episode
of care
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New Features in ICD-10-CM
Placeholder “X” Character
4.
Placeholder character
The ICD-10-CM utilizes a placeholder character “X”. The “X” is used as a
placeholder at certain codes to allow for future expansion. An example of this is
at the poisoning, adverse effect and underdosing codes, categories T36-T50.
Where a placeholder exists, the X must be used in order for the code to be
considered a valid code.
Example:
H40.11X1
Mild stage primary open-angle glaucoma
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5. 7th Characters
Certain ICD-10-CM categories have applicable 7th characters. The
applicable 7th character is required for all codes within the category, or as
the notes in the Tabular List instruct. The 7th character must always be the
7th character in the data field. If a code that requires a 7th character is not
6 characters, a placeholder X must be used to fill in the empty characters.
Example 1:
T79.0XXA Initial encounter for a traumatic air embolism
Some codes have even more!
Example 2:
W06.XXXD Subsequent encounter for a fall from a bed
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2014 ICD-10-CM Guideline Change
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New Features in ICD-10-CM cont.
• The 7th character in ICD-10-CM is used in several
chapters (for example, the Obstetrics, Injury,
Musculoskeletal, and External Cause chapters). It has
a different meaning depending on the section where
it is being used (for example, in the Injury and
External Cause sections, the 7th character often
classifies an initial encounter, subsequent encounter,
or sequelae (late effect) but may include others.
• Primarily, changes in ICD-10-CM are in its
organization and structure, code composition and
level of detail.
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Examples of the Numbers by Specialty
Specialty
# ICD-9 Codes
# ICD-10 Codes
Gastroenterologists
596
706
Pulmonologists
255
336
Urologists
389
591
Endocrinologists
335
675
Neurologists
459
591
Pediatricians
702
591
1,270
1,056
Infectious Disease
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Where are most of the new codes?
• The majority are in musculoskeletal and
injury/poisoning:
- Increased specificity of type of fracture, laterality,
specific bone and encounter information.*
- Increased doesn’t mean increased complexity, if
you take away the 7th character for encounter,
the number of codes drop significantly.
*Tip – documenting these additional elements will
simplify the ICD-10 transition.
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Questions?
Z00.121 – Routine infant/child exam with
abnormal findings
– Does this include a separate and identifiable
problem like an ear infection or is this limited
to a problem within normal growth and
development such as failing a hearing screen?
Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services
P. Encounters for general medical examinations with abnormal findings
The subcategories for encounters for general medical examinations, Z00.0-, provide codes
for with and without abnormal findings. Should a general medical examination result in an
abnormal finding, the code for general medical examination with abnormal finding should
be assigned as the first-listed diagnosis. A secondary code for the abnormal finding should
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also be coded.
Questions?
We frequently use 079.99 – Viral syndrome
And have identified a couple of options:
•B34.9 Viral infection, unspecified, or
•B97.89 Other viral agents as the cause of disease
classified elsewhere (Use of this code requires we have
diagnosed a disease.)
– When we see these kids, the disease is a basket of
symptoms that point to a viral illness. Which one
should we use?
– Let’s look at GEMS………………These can be found
on the CMS website or the CDC website
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GEMS
(General Equivalency Mapping System)
ICD-9-CM ICD-10-CM
07999
B9789
080
A750
Flag
10000
00000
Meaning
Approximate Match
Exact Match
CAUTION!
You cannot rely simply on the GEMS system to cross-match everything. If the flag
is other than “00000” there are other potential possibilities. It’s best to start in
the alphabetic index and then complete the look up process in the tabular.
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Questions?
Let’s look up Viral syndrome in ICD-10-CM
1.Alphabetic Index
2. Tabular Index
Syndrome
B34.9 Viral
Infection,
- virus B34.9
Unspecified
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Useful Website Resources to Assist!
• AHIMA: https://www.ahima.org/icd10/
• AMA: https://www.ama-assn.org/go/icd-10
• CMS: https://www.cms.gov/icd10/
• CDC: http://www.cdc.gov/nchs/icd/icd10cm.htm
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Questions?
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Next Steps
• September 17th – panel discussion with private
payers
• October 15th – panel discussion with
government payers
Email questions to marilyn_rissmiller@cms.org
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*Working for you!
www.cms.org/icd-10
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